Wednesday, February 13, 2013

A Reminder Of The Importance Of Terminology In Health Information Use and Exchange. We Still Seem To Be Struggling.

The following appeared a little while ago.

Why HIE hinges on terminology standards

By Viet Nguyen, MD, Chief medical information officer for Systems Made Simple
Data “integration” has been a buzzword for years, but only now are healthcare organizations realizing what it truly means to integrate — both within and outside their own four walls. To achieve collaboration across the entire continuum of care, a significant shift in data standardization and integration must occur. Joint efforts between the Department of Veterans Affairs (VA) and the Department of Defense (DoD) are a start, and promise to spur momentum toward communication with private health systems as well. The ultimate goal is nothing less than the creation of a longitudinal patient record that helps lower costs, enhance care and improve day-to-day efficiencies.
The eHealth Exchange is one example of a national collaboration aimed at expanding the interoperable exchange of information. Formerly known as the Nationwide Health Information Network Exchange (or NwHIN), eHealth Exchange illustrates the fact that adoption of data and terminology standards is the linchpin for health information sharing.
Toward this end, several initiatives have started to establish various sets of standards to make more interoperability efforts like eHealth Exchange a reality. The VA and DoD are working cooperatively to deploy technology systems and terminology standards that will better support care collaboration between the federal agencies. Already, the VA has adopted the Continuity of Care Document (CCD/C32), which is certified for the exchange of clinical information on eHealth Exchange. Eventually, standards will also be used to foster collaboration between federal agencies and private healthcare organizations. 
HIE hinges on terminology standards
The healthcare industry recognizes the need for standardized terminologies that can act as “universal adapters” to facilitate the flow of data and achieve interoperability among multiple organizations using disparate systems. Arriving at a consensus about exactly what they should be, however, is the difficult part. While multiple terminology standards (for example, SNOMED CT, CPT, and LOINC) already exist, not all of them have been widely adopted and implemented.
To counter this problem, the VA is seeking to introduce standard terminology that can be adopted by other government agencies — as well as the public sector — through strategic partnerships with private health IT companies. For the past several years, for example, the VA has worked to standardize terminology translations for the eHealth Exchange through the Standards and Terminology Services (STS) Support Services and the Virtual Lifetime Electronic Record (VLER) programs which aim to leverage standardized terminologies such as ICD-9 and ICD-10, SNOMED CT, CPT, and LOINC to support the interoperability of data. There are also a variety of programs focused on standardizing data across the VA and the DoD.
The VA and DoD are not the only government agencies using technology to enhance care collaboration in the healthcare setting, of course. The Centers for Medicare and Medicaid Services (CMS) is partnering with a team comprised of commercial health IT companies on an initiative called “Electronic Submission of Medical Documentation” (esMD), which is designed to give providers a more efficient way of delivering medical records needed to process claims.
Lots more here:
What I find to be interesting in all this is, despite all the investment in terminologies, the progress of actual implementation seems still to be glacial. It would be very interesting to hear what the powers that be in OZ are planning to actually see some progress. We have been waiting for a good while now.
An example of this was highlighted by NEHTA last week with this document on the Australian Medicines Terminology (AMT).
See here:
Page 4 reminds us of the saga.

History of the AMT

“2005 – Early development of the AMT model and editorial rules. This work used and further developed previous work undertaken prior to the establishment of NEHTA including: Australian Medicines and Devices Terminology developed by the DoHA in conjunction with HL7 Australia and New Zealand;
·         UK Dictionary of Medicines and Devices (dm+d);
·         Australian Catalogue of Medicines, with input from the Medicines Coding Council of Australia; and
·         SNOMED CT User Guide by IHTSDO.
March 2007 − Establishment of first external stakeholder Medicines Reference Group (superseded by AMT Support Group in April 2009).
December 2007 − AMT v1.0 released nationally to licensed SNOMED CT users for test and evaluation purposes only – not for clinical use.
June 2009 − AMT v2.0 released nationally for clinical use according to the AMT Statement of Purpose as developed following independent stakeholder review and evaluation.
2009 − AMT Model Review project underway to address issues raised during ongoing stakeholder engagement around the complexity of the model.
November 2009 − AMT v3 model agreed nationally.
November 2010 − First state-based implementation of AMT v2 achieved in Victoria.
February 2011 – AMT v3 alpha released to a limited audience.
March 2011 − First reference sets released to align with the new IHTSDO SNOMED CT RF2 specifications.
February 2012 – AMT Implementation kit released for evaluation (including v3 test preview data).
March 2012 – AMT Roadmap published.
February 2013 – AMT v3 Beta release and stakeholder feedback/training period begins (ten weeks). Some key objectives for the AMT v3 model were to:
§  Simplify the AMT model to make it easier to understand and implement.
§  Align to SNOMED CT Release Format 2 (RF2) technical specifications to become fully machine-processable.
§  Allow easier integration into SNOMED CT-AU.
§  Ease the internal build/maintain/test release processes.
§  Create a sound foundation that can be expanded to realise the longer-term AMT product development.
Key AMT implementations (both completed and under development) have provided further feedback to assist in the development of AMT v3.”
We are now into the 8th year of this and the product is still hardly used in real clinical applications.
I wonder why this is the case?
Thinking of all the NEHTA so called products it really is hard to think of one that has been anything that could be described as an adoption and use success.


Anonymous said...

"Thinking of all the NEHTA so called products it really is hard to think of one that has been anything that could be described as an adoption and use success."

Remember the "Year of Delivery", surely that was a success as January 1st 2009 came and December 31st 2009 went and that in and of itself was deemed a success by NEHTA.

You need to try much harder and be more imaginative David when it comes to identifying and acknowledging "adoption and use success" for all things NEHTA related.

Anonymous said...

Reminds me of Chindogu: The Refined Japanese Art Of Making Unuseless Inventions that nobody uses.
--- Tim C.

Anonymous said...

Dear Tim C Unuseless although not a word presumably means something that is useful. ie. useless means it has no use, therefore unuseless being a double negative means it is useful.

So ..... you were saying .... Japanese Art of Making useful things that nobody uses.

Mmmm - does that make sense. I don't think so.